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Functional Extension programming for equine owners and business operators brings unique challenges when compared to other commodity producers. The initial Tennessee Master Horse Program (TMHP) curriculum and delivery method was modeled from other successful Extension programs using a county-based, in-person training model; however, implementation of county-level offerings of the TMHP for 4 years only yielded 218 participants. Thus, our objective was to pilot a new online program format for the TMHP and to assess participant feedback to dictate future programming efforts. Data were analyzed using STATA SE 16.1 and all results are reported as mean ± SD. The THMP was hosted by the state Equine Extension Program within the Google Classroom platform and contained 12 synchronous webinars with successive recordings, 3 scenarios for participant response, 10 question submission assignments, and 14 opportunities to explore outside resources pertaining to topic areas. Topics covered included responsible horse ownership, pasture management, nutrition, forages, waste management, health and diseases, economics, and equine training programs. Total participants (n = 201) from 12 states were reached, with 162 ± 29 (min=110, max=201) live attendees each week and 35 ± 4.1 (min=15, max=61) views per recorded YouTube video. During live sessions, 56 ± 18 (min=21, max=75) questions were asked and answered, and an additional 82 ± 35 (min=43, max=140) questions per week were submitted in the Google Classroom. In the final TMHP evaluation survey, 99% (n = 95) of respondents indicated they would recommend this training to others, which may be due to highly satisfactory ratings for speakers (4.54 ± 0.15 on a 1 to 5 scale, min=1, max=5) from participants. These results indicate a high acceptance rate among participants and that an online delivery method could be an effective approach for conducting and expanding the scope of future TMHP offerings.

The equine industry is highly variable with many different sectors and management practices. To determine how the public views common management practices and discipline-specific areas of the equine industry, an online study was distributed via email and social media over a 6-week period to U.S. residents over the age of 18 (n = 1,372). Survey questions included demographics, industry connection, definition of welfare and equine classification. Respondents were asked to select the most concerning option from a series of management-related scenarios. The production livestock and equine industries were then segmented by species or discipline, respectively, and respondents were asked which sector was most problematic. To analyze the data, frequency tables (Proc FREQ) and multinomial logistic regression (Proc LOGISTIC) were used in SAS 9.4 (Cary, NC) to test the factors associated with likelihood to select a given management scenario from each series (α=0.05). Respondents who were heavily connected to the industry were four times more likely than lightly connected individuals to select that a blanketed horse or unblanketed horse in 30°F weather with unlimited access to food and water equally presented no concern than to say that a blanketed or unblanketed horse in 30°F weather with unlimited access to food and water and were concerning (OR= 4.09; 95%CL: 2.08,8.04). Of the 1,244 respondents who answered, 563 (45%) said that the gaited horse industry is the most problematic equine industry compared to the racing industry (41%) and stock horse industry (8.7%). Understanding how the public perceives the various animal industries and management scenarios in relation to an individual’s connection to the industry, classification of equines and welfare definition is important to assess and improve educational intervention strategies.

Equine welfare and processing are a major topic of interest, often debated by industry professionals and the public alike. These debates often focus on the welfare of equines during the different aspects of processing and the impacts related to the processing legislation passed in 2007. Our objective was to determine if one’s definition of welfare, industry connection, or their classification of equines was associated with their perceptions of equine processing and related impacts. Over a 6-wk period, a survey was distributed via email and social media outlets to U.S. residents over the age of 18 (n = 1,334). Participants responded to questions including demographic information, connection to the industry, equine classification, and indicated the changes they expected occurred due to the 2007 processing legislation. Furthermore, participants selected sources from which they commonly obtain information regarding animal welfare issues. Statistical significance was set at α=0.05. Multinomial logistic regression in SAS (SAS Institute, Cary, NC; PROC LOGISTIC) was used to determine factors associated with participants’ likelihood to respond “increase,” “decrease,” or “no impact” to each area in which the 2007 legislation could have impacted the industry. When asked if there was an impact on the number of horses processed, connection to the industry (P = 0.03), welfare definition (P < 0.0001) and classification of horses (P = 0.009) were associated with responses. Respondents with light connection, when compared to moderate connection, were 10 times more likely (OR=10.9; 95% Cl: 1.03, 111.1) to say there was an increase in horse processing, versus no impact, in response to the 2007 legislation. Understanding interactions between industry connection, welfare definition, classification of equids relative to current industry issues may prove beneficial to bridge an educational gap and provide clarity to important welfare concerns.

The prescribing of second-generation antipsychotics for young people has increased dramatically. Studies have shown that children enrolled in Medicaid are more likely than those with private insurance to receive antipsychotics, leading many states to require prior authorization (PA) for their use. However, little is known about how PA programs affect prescribing patterns for antipsychotics or other psychotropic medications. This study examined a PA program for second-generation antipsychotic use for children under 18 in West Virginia Medicaid. Prescribing rates for antipsychotics and other psychotropic classes were assessed.Administrative claims from West Virginia Medicaid and the Children's Health Insurance Program for September 2014 to July 2016 were examined (N=273,369 prescriptions) with an interrupted time-series design. Segmented linear regression was used to model both immediate effects and trends in prescribing rates before and after implementation of the PA program in August 2015.After PA program implementation, the prescribing rate for second-generation antipsychotics immediately dropped by 17% from prior levels, adjusted for preexisting trends, and further declined in the following months. Prescribing rates for all second-generation antipsychotics except for aripiprazole decreased significantly. Benzodiazepine prescribing increased in the month after PA program implementation but immediately returned to prepolicy rates, and sustained compensatory prescribing was not observed for any psychotropic drug class.Implementation of a second-generation antipsychotic PA program for children under age 18 resulted in a significant decrease in the prescribing rate for this class of medication, without sustained compensatory prescribing of other psychotropic classes.

Proper pasture management is an important consideration for equine owners to prevent negative environmental effects and promote equine health. When best management practices (BMPs) are not implemented, issues such as soil erosion, decreased pasture persistence, and nutrient runoff can occur. Understanding a person's current level of awareness and implementation of pasture BMPs is essential to further increase educational resources and identify target areas of educational outreach. We hypothesized that owners who keep their horses and other equids at home [HOH] and equine facility owners/managers [EFOM] will have similar awareness and implementation of pasture BMPs compared with owners that board [HOB]. An online survey (Qualtrics) was distributed via social media and email to Southern United States residents over the age of 18 (n = 328). The survey was open for 6-weeks and was distributed through social media and email. Demographics, information sources, current pasture management practices, along with awareness and implementation of BMPs were assessed. Statistical analysis was performed in SAS 9.4 (Cary, NC); frequency procedures and multinomial logistic regression was used to determine the effect of management connection to awareness and implementation of pasture BMPs (a = 0.05). Management connection played a significant role in respondents’ awareness and implementation of pasture BMPs for rotational grazing (aware, P = 0.009; implementation, P = 0.003); however, there was no significant difference for stocking rates (awareness, P = 0.07; implementation, P = 0.25). Participants, independent of management connection, who were aware of rotational grazing, when compared with not being aware, were only 4 times more likely to implement rotational grazing (OR = 4.115; 95% CI: 2.18, 27.78). However, respondents who were aware of appropriate stocking rates, when compared with not being aware, were 48 times more likely to implement an appropriate density of animals on pasture (OR = 47.62; 95% CI: 21.74–100.00). Understanding a person's connection and level of awareness is essential to help create educational materials and outreach programs to increase implementation of pasture BMPs and improve environmental stewardship at equine facilities.

Capgras syndrome is characterized by the delusional belief that a familiar person has been replaced by a visually similar imposter or replica. Rarely, the delusional focus may be objects rather than people. Numerous etiologies have been described for Capgras to include seizures. Similarly, visual hallucinations, both simple and complex, can occur secondary to seizure activity. We present, to our knowledge, the first reported case of visual hallucinations and Capgras delusions for objects that developed secondary to new onset occipital lobe epilepsy. We then discuss the possible underlying neurologic mechanisms responsible for the symptomatology.

Classification of horses as livestock or companion animals is often contested in cases of management and welfare concerns, legislation, and educational forums. Limited data are available regarding perception of equids in relationship to animal agriculture management practices. Therefore, our objective was to test associations between livestock management practices and perception of horses as companion animals or livestock. An online survey was administered for 6 weeks to U.S. residents over age 18. Participants provided demographic information, connection to the industry, and welfare definition of choice. Management questions included 2 scenarios each—one regarding horses and a direct comparison for another livestock species. Respondents then chose which scenario was most concerning or if the scenarios were equally non-concerning (i.e. no issue) or concerning. Analyses were performed using SAS (SAS Institute, Cary, NC), with significance set at α=0.05. Multinomial logistic regression (PROC GLIMMIX) was used to test factors affecting management scenario responses. Out of 1,334 respondents, 807 (60.5%) categorized equids as companion animals; 527 (39.5%) classified equids as livestock. Welfare definition, equid classification, and industry connection significantly affected responses to every management scenario (P < 0.01). People who classified horses as livestock had 2.8 times greater odds (OR=2.8; 95%CI:1.8, 4.5) to select lack of shelter during spring months as equally non-concerning for horses and cattle rather than selecting horses without shelter as a concern compared to respondents who classified horses as companion animals. Respondents heavily connected to the equine industry were less likely (OR=0.38; 95%CI:0.19, 0.75) to select that both species without shelter were concerning rather than selecting that only horses lacking shelter was concerning compared to respondents lightly connected to the industry. Understanding associations between public perceptions of livestock management and individual’s welfare definition, equine classification and industry connection may improve our ability to educate the public regarding animal agricultural practices.

Neuroleptic Malignant Syndrome (NMS) is a rare condition clinically characterized by muscle rigidity, hyperthermia, autonomic instability, and acute mental status change. NMS is most often associated with use of high-potency first-generation antipsychotic medications; though, other neuroleptics have been implicated as well. NMS can be fatal with estimated mortality rates as high as 20%. Patients experiencing certain severe complications, including renal failure, have been associated with mortality as high as 50%, stressing the need for early recognition and treatment. Here we present the case of a 54-year-old male that initially presented with symptoms suspicious for sepsis, but who eventually developed a clinical picture consistent with NMS. We describe the diagnostic and treatment process leading to symptom remission. We then discuss our decision to reintroduce an atypical antipsychotic agent, quetiapine. This case illustrates the importance of early recognition of the signs and symptoms of NMS and the need to initiate treatment promptly in order to prevent complications, including death. This case also highlights the decision to resume antipsychotic pharmacotherapy after adequate resolution of NMS, demonstrating that it can be done so safely if started at low doses coupled with intensive monitoring of the patient.

To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.A prospective observational cohort study investigating the Pediatric Confusion Assessment Method for Intensive Care Unit (pCAM-ICU) patients in the pediatric medical, surgical, and cardiac intensive care unit of a university-based medical center.A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.None.Criterion validity including sensitivity and specificity and interrater reliability were determined using daily delirium assessments with the pCAM-ICU by two critical care clinicians compared with delirium diagnosis by pediatric psychiatrists using Diagnostic and Statistical Manual, 4th Edition, Text Revision criteria.A total of 146 paired assessments were completed among 68 enrolled patients with a mean age of 12.2 yrs. Compared with the reference standard for diagnosing delirium, the pCAM-ICU demonstrated a sensitivity of 83% (95% confidence interval, 66-93%), a specificity of 99% (95% confidence interval, 95-100%), and a high interrater reliability (κ = 0.96; 95% confidence interval, 0.74-1.0).The pCAM-ICU is a highly valid reliable instrument for the diagnosis of pediatric delirium in critically ill children chronologically and developmentally at least 5 yrs of age. Use of the pCAM-ICU may expedite diagnosis and consultation with neuropsychiatry specialists for treatment of pediatric delirium. In addition, the pCAM-ICU may provide a means for delirium monitoring in future epidemiologic and interventional studies in critically ill children.

Datura stramonium is a wildly growing plant found in West Virginia and in temperate regions throughout the world that is sometimes abused by young people because of its hallucinogenic effects. D. Stramonium overdose produces a classic anticholinergic syndrome that can lead to severe and sometimes fatal complications. Poisoning can be confused with more commonly seen drugs of abuse, particularly synthetic drugs which are not revealed by standard drug screens. Misdiagnosis can delay appropriate care and potentially lead to poorer outcomes. We present a case of a 15 year-old male with acute D. Stramonium poisoning initially misdiagnosed with bath salt intoxication who required treatment by two emergency departments, a pediatric ICU, and who was ultimately transferred to an inpatient psychiatric facility. We then discuss differential diagnosis of D. Stramonium poisoning and bath salt intoxication and present management strategies for the two conditions.

CNS stimulants are the third most commonly prescribed medication class in the United States for children under the age of 18. Although they are most often used safely, they can be associated with a number of side-effects, including movement disorders. Acute chorea is a rare but known side-effect of stimulant use that has been primarily described in adults. We present the case of a 10-year-old girl who developed chorea after starting long-acting methylphenidate.